Brock Slabach, MPH, FACHE Senior Vice President for Member Services National Rural Health Association. The 2012 Indiana Public Policy Forum NRHA Federal Update. Improving the health of the 62 million who call rural America home. NRHA is non-profit and non-partisan. 2012 Meetings.
Senior Vice President for Member Services
National Rural Health Association
The 2012 Indiana Public Policy Forum
NRHA Federal Update
Improving the health of the 62 million who call rural America home.
NRHA is non-profit
Deadline is Feb. 8
(Eligible candidates for student awards include residents, undergraduate, graduate, technical/vocational, community/junior college students.)
Visit RuralHealthWeb.org to submit a nomination online.
NRHA’s Principles America home.The Solution:
To resolve the health care crisis in rural America, the rural health care safety net must be prevented from crumbling. Four reforms are crucial:
it is not…urban
- IOM 2005
From 1980 to 1991 at least 360 rural hospitals were closed. -An average of 30 per year.
The Inpatient Prospective Payment System (PPS) led to the decline in the numbers of rural hospitals.
* Reported to date
Source: CBPP survey
Rural Hospital Proposed Cuts billions
MedPAC billions joins in the assault on CAHs
Budget Control Act (BCA) of 2011mandated the creation of the Joint Select Committee on Deficit Reduction (Super Committee)
A majority of Committee members had to approve the proposal before submission.
Proposal needed to produce $1.2 trillion in deficit reduction over 10 years.
Super Committee Timeline billions
The Committee had to present plan for deficit reduction by Nov. 23, 2011
The Committee announced that it was unable to come to an agreement on Nov. 21, 2011
Because the Super Committee failed to come up with a firm proposal/plan, sequestration will take affect.
Note that if Congress wants to change BCA, they have until Jan. 2013 to do so.
What is a “Sequester”?
This process, sometimes referred to as “the trigger,” includes the cancellation of budgetary resources.
The automatic process for deficit reduction involves several steps and calculations. These calculations are dependant on various outcomes, i.e. federal receipt changes, appropriated outlays, growth in Medicare/Medicaid, etc.
According to the Congressional Research Service, “The precise implications of the automatic spending reduction process cannot be assessed at this time.”
Sequestration Cont. billions
Medicare provider reimbursements will be cut 2%. Medicare will not alter procedures (DRGs) and will not limit beneficiary services.
Medicaid and Social Security will not be part of the automatic cuts.
Total cuts will equal the $1.2 trillion dollar Super Committee goal.
The total increase allowed for new borrowing authority will be $1.5 trillion
Sequestration Cont. billions
Some groups are asking that Congress modify the programs that are protected in sequestration.
Asking for modifications to defense share, discretionary account cuts, types of Medicare cuts, etc.
Some groups are claiming that modifications would require congressional action while others point to executive discretion in the administration of the cuts.
Sequestration Cont. billions
President has promised not to lift the sequester or modify the implementation of cuts.
Congress may attempt to override a veto before the cuts take affect in 2013. Unlike the up or down vote for a Super Committee proposal, the override must occur in “normal order”.
The caps, cuts, modified payments are set to continue until 2021.
Appropriations Conference Report billions
Funding levels for “Rural Health” chapter remained the same
The National Health Service Corps was funded at $295 million-$24 million below FY 2011 but $130 million above FY 2010
Title VII, Title VIII and NHSC funding was lower than FY 2011 but significantly higher than the House had originally allocated
AHECs were funded at $30 million—Title VII as a whole funded near FY 2011 levels
Title VIII funded at $466 million
“Medicare Extenders” billions
Various provisions have expired or are set to expire at the end of FY or CY 2011
Hospital wage index improvement
Extension of outpatient hold harmless provision
Other 2011 Provisions billions
Extension of exceptions process for Medicare therapy caps
Extension of payment for the technical component of certain physician pathology services.
Extension of the work geographic index floor under the Medicare physician fee schedule.
2011 Continued billions
Extension of ambulance add-ons
Extension of physician fee schedule mental health add-on
Other Extenders billions
A second group of “extenders” are set to expire at various points in 2012:
Medicare Dependant Hospital
Extension of improved payments for low-volume hospitals
Extension of Medicare reasonable costs payments for certain clinical diagnostic laboratory tests furnished to hospital patients in certain rural areas
Extension of Community Health Integration Models
Extension of Payment for Qualifying Hospitals in Low Spending Counties
Medicare payments to hospitals 50 beds represent 2percent of the total Medicare budget.
What to say to the Staffers clinical diagnostic laboratory tests furnished to hospital patients in certain rural areas
What to say to the Staffers Cont. clinical diagnostic laboratory tests furnished to hospital patients in certain rural areas
What is your payer mix of private payers compared to Medicare/Medicaid? What is the makeup of your community? (Economic ability to pay, high proportion of seniors, percentage of population w/insurance, etc.)
What is the economic impact of the facility in the community? (Largest employer, statistics on money brought into the community, etc.)